For twenty years the World Health Organisation (WHO) has recognised tuberculosis (TB) as a renewed threat to global health. Progress had been made in stabilising numbers affected by the disease with vaccines and targeted treatment, but the emergence of new drug-resistant strains of mycobacterium tuberculosis and shortages of medication has meant a decline in the effectiveness of treatments. This has been particularly devastating for health in Papua New Guinea (PNG), which now has the highest rate of TB in the Pacific region with around 15,000 cases, registered annually of which 3,500 prove fatal.

TB is prevalent in the environment and can be transmitted through tainted food and water or by inhalation of droplets produced by an infected person’s coughs or sneezes. TB is highly contagious so that even breathing air close to a person carrying the bacteria can put you at risk. Only 10% of people infected will develop the disease. Eating a healthy diet and getting enough sleep and exercise can help to build immunity and guard against the severity of its effect as well as play an important role in recovery, but poor living conditions increases the risk of developing TB and hampers recovery, and underfunded care systems result in increased fatalities.

Treatment problems

A cure of even the common forms of TB involves four different antibiotics and six months of treatment. The symptoms usually clear up quickly although the disease is still present. This means that close supervision of patients is necessary, particularly as side-effects can damage the liver or eyesight. In PNG it is common for patients to receive only partial treatment, which means a relapse is more likely and the bacteria may mutate into a new strain of drug resistant TB (XDR-TB) or multiple drug resistant TB (MDR-TB). New drugs used against MDR-TB may be less effective, require a longer course of treatment or be more toxic to the patient and more expensive, further straining an underfunded health system. The control of tuberculosis worldwide requires early diagnosis, effective medication and completion of a patient’s course of treatment.

The view from Australia

The prevalence of TB in Australia is low, with numbers at about 12,000 annually, 85% of which occur among people born overseas. The percentage of MDR-TB cases is stable at about 2%. Numbers of cases transmitted within Australia is low. However, the disease is able to spread south from PNG across the Torres Straits, with symptoms developing only months or even years after the patient has settled in Australia. In 2011 Australia increased its support for PNG’s fight against TB to the tune of $1.1 million. In October 2013 Australia’s Burnet Institute, an NGO dedicated to improving the health of poor and vulnerable communities, launched its Stop TB campaign. The institute’s infectious diseases expert Dr Emma McBryde had spent two weeks in PNG’s western province assessing the TB situation. She said: ‘Not only were there vast numbers of tuberculosis specific beds in every hospital but almost every bed in every hospital was taken up by patients who had TB or were suspected to have TB or were likely to have TB.’

The HIV/AIDS and addiction problems

Many TB patients contract the disease as a result of reduced immunity due to HIV/AIDS, which has increased in PNG over recent years despite progress in HIV/AIDS treatment – to a large extent because of the country’s diverse geography and culture and its communication and transportation problems. However, this trend has showed signs of stabilizing and declining in the last 5 years. High levels of casual sexual activity, alcohol and drug use, and the difficulty of educating the population about preventing the spread of HIV have made its containment difficult. The risk of contracting TB increases in people who consume alcohol in quantities above 40g per day, or if they have an addiction problem, either to alcohol or other recreational and illicit drugs, which is a major problem in PNG. TB and other infectious diseases including HIV/AIDS are particularly prevalent among addicts who inject drugs, although there is no evidence that injection drugs users exists in PNG. There is now also the problem of increasing acquired HIV Drug resistance, which alongside the growing problem of MDR-TB creates a picture of disease in the country that only greater investment in the health and education services will begin to solve.

The challenge for the future

Supply, transportation and communications are still major problems. The Burnet Institute’s Dr Emma McBryde said: ‘Occasionally people will turn up to a clinic to be told there are no drugs available. There are other challenges as well. People might live in a rural community but their treatment service might only be a short distance away by our terms, but if they have to use a long boat to get there and that costs money, and takes a long time, then it’s very hard to access healthcare.’

According to the PNG National Department of Health, one person dies from TB in PNG every two hours. The increasing incidence of MDR-TB makes the challenge of combating the TB problem even more pressing. The WHO 2013 update on the global response to the problem of MDR-TB shows that its 2009 targets for patients enrolled on courses of treatment fell short in 2011 by about 80,000 and that projections based on the current figure still fall short, with an ever-widening gap between 2009 and current projections. However, it does say that ‘48% of patients with MDR-TB enrolled on treatment in 2009 were reported to have been successfully treated.’

New facilities

In July 2013 a new TB ward with 22 beds was opened at Daru General Hospital with financial support from the Australian government to provide ‘targeted assistance to help the PNG government address TB in the Western Province.’ This is the first isolation ward in PNG that complies with international standards for the care of patients with infectious diseases, with 6 isolation rooms for patients with infectious TB and accommodation and washing facilities for careers. The Australian government also pledged over $30 million for the support of health services in PNG, including specialist TB doctors and nurses, community health training, a sea ambulance, laboratory diagnosis, the upgrading of Daru Hospital and Mabaduan Health Centre and improvements to Western Province primary health care.

The new facilities were opened by the PNG Hon Minister for Health and HIV, The Hon Michael Malabag MP, with Australia’s Parliamentary Secretary for Pacific Island affairs, Senator The Hon Matt Thistlewaite, who said: ‘This is the approach Australia supports and it is saving lives. Data from Daru Hospital shows that mortality rates from multi-drug resistant TB fell from 25% to 5% between 2011 and 2012.’

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